Healthcare Provider Details

I. General information

NPI: 1841570447
Provider Name (Legal Business Name): GEORGE SONCRANT D/B/A BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 RIVERSIDE DR SUITE 180
GREEN BAY WI
54301-1653
US

IV. Provider business mailing address

3000 RIVERSIDE DR SUITE 180
GREEN BAY WI
54301-1653
US

V. Phone/Fax

Practice location:
  • Phone: 920-632-7040
  • Fax: 920-632-7262
Mailing address:
  • Phone: 920-632-7040
  • Fax: 920-632-7262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: KIM SLAMP
Title or Position: OFFICE MANAGER
Credential:
Phone: 920-632-7040